Dr. Troy Tyner, D.O. April 6,2017 Goals for Session CMS Grant - - PowerPoint PPT Presentation

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Dr. Troy Tyner, D.O. April 6,2017 Goals for Session CMS Grant - - PowerPoint PPT Presentation

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PHA/KPP Kettering Health Network: A Deep Dive on the Quality Category of MIPS Dr. Troy Tyner, D.O. April 6,2017 Goals for Session CMS Grant Update for PHA Members Overview of our PHA/KPP goals Ensure You Pay NO Penalties

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PHA/KPP Kettering Health Network: “A Deep Dive on the Quality Category of MIPS”

  • Dr. Troy Tyner, D.O.

April 6,2017

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Goals for Session

  • CMS Grant Update for PHA Members
  • Overview of our PHA/KPP goals
  • Ensure You Pay NO Penalties
  • Overview of MIPS
  • Update on MIPS and Data Submission
  • Ensure you know your practice scores
  • Ensure You Pay NO Penalties
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PHA CMS Grant Status

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Clinicians: 496 involved Successes:

  • 300 site interactions in Q1 2017 with practices
  • Practices made strong progress
  • Several practices that would have failed to submit PQRS in

2016 were able to successfully meet requirements.

  • All practices have taken the minimum required steps to avoid

the MIPS penalty.

  • Opportunities:
  • Practices using Epic Ambulatory EHR report difficulty getting

quality reports, determining reportable measures, and access to understanding Epic reporting requirements and capabilities.

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PCP Phase Scores

Phase 1 (Action Plan)

  • Set Aims – 23
  • Phase 2
  • Use Data to Drive Care – 106
  • Phase 3
  • Achieve Progress on Aims – 19

Phase 4

  • Achieve Benchmark Status – 0

Phase 5

  • Thrive as a Business in Pay-for-Value Approached – 0

PHA/KPP 2017 Goal Drive 100% that desire to Phase 3

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Specialist Phase Scores from PAT

Phase 1 (Action Plan)

  • Set Aims – 51

Phase 2

  • Use Data to Drive Care – 413

Phase 3

  • Achieve Progress on Aims – 3

Phase 4

  • Achieve Benchmark Status – 0

Phase 5

  • Thrive as a Business in Pay-for-Value Approached – 0

PHA/KPP 2017 Goal Drive 100% that desire to Phase 3

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Medical Advantage Group

Experienced team brings years of success and knowledge in areas that align with the requirements of MIPS Medical Advantage Group’s experience has resulted in:

– 196,445 gaps closed from end of 2014 to Nov. 2016. From 45% to 69% in gaps closured. – 176 PCMH practices – Increased PMPM earning to our

  • physicians. In 1 contract alone,

increase of $9.15 PMPM in 2 years. – PCPs earned > $1,900,000 and specialists earned $1,800,000 in value-based incentive payments

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$5.36 $11.80 $14.51 $0.00 $1.00 $2.00 $3.00 $4.00 $5.00 $6.00 $7.00 $8.00 $9.00 $10.00 $11.00 $12.00 $13.00 $14.00 $15.00 $16.00 $17.00 $18.00 Total 2014 Total 2015 Total 2016

CIPA PGIP INCENTIVE/ADMINISTRATIVE PAYMENTS TO PHYSICIANS AND

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Deep Dive into MIPS

Beth Hickerson and Angela Hale Quality Improvement Advisors PHA Physicians April 6, 2017

Value Driven.Health Care. Solutions.

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MIPS SUMMARY Acronyms and Basics

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Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

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Supported by organized medicine

– Repealed the Sustainable Growth Rate (SGR) methodology – Passed with over 90 percent support in both the House and Senate; bi-partisan legislation

Created Quality Payment Program which moves Medicare into value-based payments

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Quality Payment Program (QPP)

January 1, 2019 – physicians enter the APM track or the MIPS track For the first few years, majority of clinicians in MIPS

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Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) Alternative Payment Model (APM)

Advanced APM MIPS APM

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Acronym Reference

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MIPS Payment Adjustments

Final score of 0-100 calculated for each eligible clinician/group based on performance in four categories Final score compared against threshold to determine payment adjustment to MPFS First MIPS performance year- 2017 First MIPS payment year-2019

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Threshold

4x% 5x% 7x% 9x%

  • 4x%
  • 5x%
  • 7x%
  • 9x%

2019 2020 2021 2022

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Example of MIPS Negative Adjustment

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MPFS Reimbursement 2017 data/ 2019 payment 2018 data/ 2020 payment 2019 data/ 2021 payment 2020 data/ 2022 payment Maximum Loss 4% 5% 7% 9% $50,000 $2,000 $2,500 $3,500 $4,500 $100,000 $4,000 $5,000 $7,000 $9,000 $400,000 $16,000 $20,000 $28,000 $36,000

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Example of MIPS Positive Adjustment

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MPFS Reimbursement 2017 data/ 2019 payment 2018 data/ 2020 payment 2019 data/ 2021 payment 2020 data/ 2022 payment Plus or Minus 4% 5% 7% 9% Bonus 10% 10% 10% 10% 10% $50,000 $7,000 $7,500 $8,500 $9,500 $100,000 $14,000 $15,000 $17,000 $19,000 $400,000 $56,000 $60,000 $68,000 $76,000

Value Driven.Health Care. Solutions.

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MIPS Final Score for 2017 Performance Year

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Final Score Payment Adjustment ≥70 points – Positive adjustment – Eligible for exceptional performance bonus – minimum of additional 0.5% 4-69 points – Positive adjustment – Not eligible for exceptional performance bonus 3 points – Neutral payment adjustment 0 points – Negative payment adjustment of -4% – 0 points = does not participate

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MIPS Category Weights Over Time

:

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Quality Advancing Care Information Improvement Activities Cost

Replaces PQRS Replaces MU New (PCMH) Replaces VBM

2017 60% 25% 15% 0% 2018 50% 25% 15% 10% 2019+ 30% 25% 15% 30%

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MIPS Eligible Providers

Years 1 and 2 Medicare Part B clinicians:

Physicians MD, DO Podiatrists Optometrists Chiropractors Dentists Physician Assistants Nurse Practitioners Clinical Nurse Specialists Certified Registered Nurse Anesthetists

Year 3+ Medicare Part B clinicians:

Occupational Therapists Physical Therapists Speech Therapists Audiologists Nurse Midwives Clinical Social Workers Dietitians

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MIPS Exempt Providers

3 groups of clinicians:

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First year of Medicare Part B participation Below low patient volume threshold Certain participants in ADVANCED Alternative Payment Models

100 or fewer Part B patients OR billing no more than $30k/year

NOTE: MIPS does not apply to hospitals or facilities

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Pick Your Pace Options

Three options to participate in MIPS in 2017:

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Don’t submit

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Three Ways to Avoid the Penalty in 2017

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1

Quality Measure

1

Improvement Activity

5

Required

Advancing Care Information Measures OR OR

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Physician Compare Website

Shows MIPS composite scores and individual performance category scores Patients can see health care providers rated on a scale of 0 to 100 and how physician compares to peers nationally

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REPORTING OPTIONS AND METHODS Understanding How to Report

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Reporting Options

Individual – defined as a single NPI tied to a single TIN

– May protect incentive potential for high-performing providers – May be easier if you have NPIs not required to report

Group – multiple NPIs that share a common TIN

– May ease administrative burden – Beneficial if you have some providers with reporting

  • bstacles

– Register only if using CMS web interface or CAHPS for MIPS

Note: Reporting option applies for all four categories; NPIs must report for each TIN separately

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Reporting Methods

Claims EHR Registry Qualified Clinical Data Registry CMS Web Interface CAHPS for MIPS Survey Note: You may only report via one method per category

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Reporting Methods (cont.)

Claims

– Add modifier codes to your Medicare claims – Can be added manually by billers or automatically by EHR or billing software

EHR

– Directly submit a QRDA III file through the CMS portal – Register with your EHR to submit on your behalf as/through a Data Submission Vendor (DSV) – This category does not include EHRs who submit via registry

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Reporting Methods (cont.)

Registry

– Entity that collects data and submits to CMS – Clinical data can be extracted from EHR or manually entered via registry web form – Claims data can be submitted via registry

Qualified Clinical Data Registry (QCDR)

– CMS-approved entity that collects medical and/or clinical data for the purpose of patient disease tracking to foster improvement in quality of care – Usually includes specialty measures not on the general MIPS measures list – Clinical data can be extracted from EHR or manually entered

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Reporting Methods (cont.)

CMS Web Interface (GPRO)

– Groups of 25 or more – Populate data (manually or electronically) and report all GPRO measures on 248 identified attributed patients – Must register by June 30, 2017

CAHPS for MIPS

– Survey of patients administered and submitted by approved vendor – Counts as one of six required measures – Must submit remaining five measures via other method – Earn extra bonus points

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Data Completeness Rule

Claims – 50% of all Medicare Part B patients EHR, Registry, QCDR – 50% of all patients GPRO – all patients assigned, up to 248

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Reporting Methods

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QUALITY CATEGORY Requirements and Scoring

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Quality Reporting Requirements

Report six measures, including at least one outcome or high priority measure Select from full list of 291 MIPS measures Or select from a set of specialty specific measures

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3-10 points per measure based on performance against a benchmark 60 possible points Bonus points for high-priority and EHR reporting

60

Points

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Measure Choices

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https://qpp.cms.gov/measures/quality

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Selecting Measures

1. Decide on your reporting method – Claims, EHR, Registry, QCDR

– Reporting via EHR is easiest but may limit choice of measures

2. Compile list of all available measures for your chosen method 3. Narrow your list to include only applicable measures

– Specialty/scope of practice – Patient population – Data collection limitations

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Selecting Measures (cont.)

  • 4. Calculate your estimated MIPS points per measure

https://qpp.cms.gov/resources/education “2017 Quality Benchmarks”

34 Value Driven.Health Care. Solutions. Measure_Name Submission Method Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9 Decile 10 Pneumonia Vaccination Status for Older Adults Claims 39.78 - 51.32 51.33 - 61.67 61.68 - 70.47 70.48 - 77.77 77.78 - 84.49 84.50 - 91.99 92.00 - 99.06 >= 99.07 Pneumonia Vaccination Status for Older Adults EHR 14.13 - 23.25 23.26 - 33.02 33.03 - 43.58 43.59 - 53.96 53.97 - 63.60 63.61 - 74.54 74.55 - 85.52 >= 85.53 Pneumonia Vaccination Status for Older Adults Registry/QCDR 12.24 - 24.02 24.03 - 36.34 36.35 - 48.51 48.52 - 58.95 58.96 - 68.05 68.06 - 77.77 77.78 - 90.19 >= 90.20

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Quality Scoring Basics

Each measure earns between 3 to 10 points Minimum 20 cases for a measure to earn performance points above the minimum Some measures may have a maximum < 10 Reporting additional outcome and high priority measures yields bonus points Measures reported via “electronic end-to-end” method earn 1 bonus point

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Quality Scoring Tips

If you submit > six measures, CMS will use the highest scoring six for your base score Measures submitted but not scored are still eligible for bonus points Groups with 16 or more providers and 200+ eligible cases will have All-Cause Hospital Readmission

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Quality Category Score

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ADVANCING CARE INFORMATION CATEGORY Requirements and Scoring

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ACI Basics

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– Security risk analysis – e-Prescribing – Provide patient access – Send summary of care – Request/accept summary of care – 5 percent per measure for public health/clinical data registry reporting – 10 percent for improvement activity alignment – Submit nine measures for 90 days for performance credit

Required base score (50) Performance score (up to 90) Bonus score (up to 15)

50 90 15

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Choosing Your Objectives/Measures List

https://qpp.cms.gov/measures/aci

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2017 Transition Objectives and Measures

Core 1. Security Risk Analysis 2. e-Prescribing 3. Provide Patient Access 4. Health Information Exchange Performance 1. Provide Patient Access 2. Health Information Exchange 3. View, Download, or Transmit (VDT) 4. Patient-Specific Education 5. Secure Messaging 6. Medication Reconciliation 7. Immunization Registry Reporting

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Performance Measure Scoring

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Performance Rates for Each Measure

1-10% = 1 11-20% = 2 21-30% = 3 31-40% = 4 41-50% = 5 51-60% = 6 61-70% = 7 71-80% = 8 81-90% = 9 91-100% = 10

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ACI Category Score

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ACI Scoring Tips

Start improving your performance measure scores above previous MU thresholds

– Provide Patient Access – Health Information Exchange – Patient Specific Education – Medication Reconciliation

Consider implementing an Improvement Activity using your EHR to get 10 bonus points Consider reporting to a specialized registry or public health department for 5% bonus

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IMPROVEMENT ACTIVITIES CATEGORY Requirements and Scoring

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Improvement Activities Basics

Attest to completing up to four activities at least 90 days during the year Rural, health professional shortage area (HPSA), or group practices with 15 or fewer clinicians attest to only two activities Eligible clinicians choose from 92 activities in nine categories

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  • 1. Expanded

Practice Access

  • 2. Population

Management

  • 3. Care

Coordination

  • 4. Beneficiary

Engagement

  • 5. Patient

Safety and Practice Assessment

  • 6. Participation

in an APM

  • 7. Achieving

Health Equity

  • 8. Integrating

Behavioral and Mental Health

  • 9. Emergency

Preparedness and Response

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Examples of Improvement Activities

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After hours access to care Same day appointments Extended

  • ffice hours

Test tracking system

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Improvement Activities Scoring

40 points needed to maximize this category Medium-weighted activities worth 10 points High-weighted activities worth 20 points Points doubled for rural, HPSA, or small group practices (15 or fewer providers) Full credit for clinicians in CPC+, in a PCMH, or in similar specialist practice

– PCMH certifications for MIPS include: a national program, a regional or state program, a private payer, or other body that certifies at least 500 practices

Participation in Transforming Clinical Practice Initiative is a high-weighted activity

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Selecting Improvement Activities

https://qpp.cms.gov/measures/ia

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COST CATEGORY Requirements and Scoring

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Cost Basics

In 2017, cost does not impact MIPS score Clinicians are not required to submit cost data to CMS

– CMS assesses clinicians based on Medicare claims data

CMS compares resources used to treat similar care episodes and clinical condition groups across practices Cost measures adjusted for geographic payment rates and beneficiary risk factors Find previous cost information for your practice in your 2015 Annual Quality Resource and Use Report (QRUR)

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Questions?

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Beth Hickerson

bhickerson@medicaladvantagegroup.com

Angela Hale

ahale@medicaladvantagegroup.com

Value Driven.Health Care. Solutions.